Routine Screening for Domestic Abuse (DA)

Vasumathy Sivarajasingam is a GP Partner at Hillview Surgery, Perivale, West London.

Raising public awareness of Domestic Abuse (DA) is the first step forward in our battle to combat the detrimental health consequences of the abuse. DA is a global public health problem and is “everyone’s business”. The financial burden to the NHS is enormous as a result of the physical and psychological impacts on the victims/survivors and their family, including children. The cost of domestic abuse, in both human and economic terms, is so significant that even marginally effective interventions are cost effective.¹

Public health campaign to raise awareness is not enough. A victim will experience abuse on average for three years before getting effective help, and will visit their GP 4.3 times.² I feel the “personal touch” from a clinician in a general practice will have a positive impact towards improving DA awareness in the community, in addition to offering information on support/services available to the victims and perpetrators. This I believe is the step towards reducing DA.

Evidence suggests that routine or universal healthcare screening for DA improves levels of victim identification in primary care settings.^3,4 Many studies have found that lack of time is a provider barrier to screening and self-administered screening can overcome this barrier.³ While screening increases identification, there is insufficient evidence to justify screening in health care settings.⁵

Lockdown restrictions, financial difficulties, social isolation of the COVID-19 pandemic may all force victims to stay indoors with the perpetrators; usual channels of support are now jeopardised. Other reasons why victims face barriers to seeking help include stigma, shame, fear of reprisal, financial implications and perceptions that help/support may not be available. In addition, a few of the victims do not realise they are experiencing DA.

Phone, email and video consultations are being used in place of face to face consultations during the pandemic by most GP surgeries whenever possible, and probably will continue beyond the pandemic because of ease of access to clinicians. With such consultations, we need to be even more vigilant about asking questions about DA, ensuring the safety of the patient. It is hard to assess who is on the other side and many people experiencing DA may find it difficult to say what is happening to them when they are actually speaking from their home rather than a neutral place like the surgery. In practice, it is challenging for clinicians when consulting remotely to ask and encourage patients to talk about underlying issues, especially in a busy clinic.

GPs, nurses and clinical pharmacists are in a key position for early identification in our day to day work. We have a dual role as providers, seeing victims and perpetrators of DA in General Practice. Challenges imposed due to the current acute natural pandemic require us to review the guidance and practice in our health care system, especially in primary care setting.

There is no doubt that educating and training health professionals to recognise and support victims of DA is of paramount importance. Staff should be aware of the referral pathways and information on supporting services for victims/survivors and perpetrators of DA. However, with the new ways of remote working/digital consultation, we need to look at alternate means of how we could approach and identify the victims.

Raising awareness of the consequences of DA in our practice population is equally important if we want to make a change to the lives of victims. In practice, we see victims who are unaware of the support services available should they need help. It is good clinical practice to routinely ask patients, even where there are no indicators of such abuse.

This could be in the form of a screening tool that we use on all patients (males and females) contacting the clinicians. We can achieve this by using a short, simple, safe, non-threatening screening tool in a busy clinic. By informing all patients about the referral pathways/DA directory with local services (including Advocate Educator if available) irrespective of the screening tool scores, we can educate our community of the support available. I feel this will reduce the stigma/shame and fear of patient approaching clinicians. In addition, by promoting our surgeries as “DA aware practice”, with clear signposting information on our practice website will ensure survivors can self-refer to the local service.

Raising public awareness of DA encourages open discussions and helps victims to recognise and acknowledge the abuse they are experiencing. This may ensure victims and perpetrators get the necessary help and support. Ultimately this will reduce the detrimental effects of DA, reducing the financial burden of the country.

References:

1. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/597435/DometicAbuseGuidance.pdf
2. https://safelives.org.uk/sites/default/files/resources/Pathfinder%20GP%20practice%20briefing.pdf
3. https://www.omicsonline.org/costs-effectiveness-of-domestic-violence-screening-in-primary-care-settings-a-comparison-of-methods-2161-0711.1000253.php?aid=21265
4. https://whatworks.college.police.uk/toolkit/Pages/Intervention.aspx?InterventionID=54
5. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007007.pub3/full

Featured photo by Mika Baumeister on Unsplash